Title
Early Use of Novel Shockwave L6 Intravascular Lithotripsy System for Treatment of Severe Heavily Calcified Abdominal Aorta Stenosis
Introduction
Severe vascular calcification negatively impacts procedural and late outcomes following endovascular treatment of peripheral artery disease. To date, calcium modifying technologies to facilitate vascular intervention have been limited by vessel size, depth and eccentricity of calcium distribution. We present this early endovascular case with use of the novel Shockwave L6 catheter for endovascular treatment of aortic calcification.
Clinical Case
65-year-old female with a past medical history of coronary artery disease, hyperlipidemia, hypertension and diabetes mellitus was referred for evaluation and treatment of severe, bilateral lifestyle limiting claudication in August 2022. Aorto-iliac duplex study showed marked velocity elevation (~400 cm/sec) in distal abdominal aorta consistent with a severe stenosis. Monophasic flow was noted in bilateral iliac systems. Diagnostic angiography via right radial artery showed a severely calcified, 90% stenosis of the distal abdominal aorta, 75% stenosis in the distal left superficial femoral artery (SFA) and occluded anterior tibial arteries bilaterally.
Abdominal CTA showed a heavily calcified, greater than 90% stenosis of the infrarenal abdominal aorta with a reference vessel diameter of 12-14 mm. Revascularization options including both endovascular and surgical approaches were discussed and the patient was referred for surgical consultation due to the severity of vascular calcification. Due to concerns about her surgical risk she elected to proceed with an endovascular approach.
The patient returned to the catheterization lab for the interventional procedure in early November 2022. A 25 cm 8 Fr Brite tip sheath was placed via right common femoral artery and a 5 Fr sheath was placed via right radial artery. A 150 cm support catheter was advanced to the abdominal aorta via the right radial sheath to provide detailed imaging of the abdominal aorta during the intervention. A 0.018” guide wire was advanced across the abdominal aortic stenosis via the femoral sheath. Intravascular lithotripsy (IVL) was performed (180 pulses) in the abdominal aorta using a 12x30 mm Shockwave L6 balloon with 6 sonic emitters inflated to 3 atm. An 11x39 Viabahn VBX balloon expandable covered stent was then deployed in the abdominal aorta followed by multiple post-dilatation inflations with a 14x20 balloon. The final abdominal aortogram was performed showing an excellent angiographic result.
Discussion
A severely calcified abdominal aorta stenosis was treated with the novel Shockwave L6 balloon and a Viabahn covered stent. The Shockwave L6 balloon expands safe and effective IVL facilitation of endovascular intervention to large vessels including the abdominal aorta.